Air medical services facts for kids

A Sécurité Civile EC145 helicopter helps with rescue operations in France.

Air medical services use aircraft like helicopters and airplanes to move sick or injured people. They transport patients to hospitals or from accident scenes. Special medical teams provide care during these flights. This can be for emergencies or for moving patients over long distances.

Using aircraft for medical transport started during World War I. It became much more common in the Korean War and Vietnam War. Later, these services began helping civilians too. Helicopters are great for bringing expert medical care quickly to an accident scene. They can also take patients to special hospitals, especially for serious injuries. Airplanes are used for longer trips.

In some faraway places, air medical services even help with regular doctor appointments. A famous example is the Royal Flying Doctor Service of Australia. They also provide emergency care.

Why Air Medical Services Are Great

Air medical services can travel much faster than ground ambulances. They can also cover a much larger area. This makes them super helpful in rural places where people live far apart.

They are especially good for serious injuries, like major accidents. There's a theory called the "golden hour". It suggests that getting seriously injured patients to a special hospital very quickly can save lives. Helicopters can bring highly trained medical teams to the scene. They can also transport patients faster to a trauma center, which is a hospital equipped for serious injuries. They also help move patients needing critical care from smaller hospitals to these bigger trauma centers.

When to Use Air Transport

A Eurocopter EC145 helicopter from Switzerland's Rega air rescue service.

Deciding if a patient needs a helicopter depends on their condition. There are special rules and training to make sure the right choice is made. If the rules are too strict, patients might not get fast care. If they are too relaxed, patients might be flown unnecessarily. This could expose them to risks like bad weather.

The most important thing is the safety of the crew and the patient. Before a flight, they check the weather, air traffic, and distance to the hospital. A general safety rule for the crew is: "3 to go, 1 to say 'NO'". This means if even one crew member feels unsafe for any reason, the flight is cancelled.

Some people have worried about the safety of air medical services. While the number of crashes has sometimes increased, so has the number of flights and programs. Accidents are more likely at night, in bad weather, or if there's a fire after a crash.

Air ambulances often have bright colors, like these Ornge helicopters in Ontario, Canada.

What is an Air Ambulance?

An air ambulance is a special aircraft, either a helicopter or a plane. It's designed to carry injured or sick people. They are used in medical emergencies or when it's too far or difficult for a regular ambulance to reach. These operations are called aeromedical. Sometimes, the same aircraft might also search for missing people.

Just like ground ambulances, air ambulances have important medical equipment. This includes medications, machines to help with breathing (ventilators), heart monitors (ECG), and stretchers. An air ambulance with medical staff provides care during the flight. If it's just transporting patients without care, it's called a "casualty evacuation."

Air Traffic Control (ATC) gives special priority to air ambulances. This is like a ground ambulance using its lights and siren. When an air ambulance is carrying a patient, it uses the call sign MEDEVAC. This helps them get priority in the air and on the ground.

History of Air Ambulances

Military Use

The Bell H-13 Sioux was the first helicopter used for medical evacuation during the Korean War.

The idea of using aircraft as ambulances started in the military. It's almost as old as powered flight itself! During World War I, people started experimenting with air evacuation.

The first recorded British ambulance flight was in 1917. A soldier with a foot injury was flown to a hospital in 45 minutes. This journey would have taken three days by land! In the 1920s, several air ambulance services began around the world. Aircraft were still new and limited back then.

France and the United Kingdom used organized air ambulance services in wars during the 1920s. By 1936, a military air ambulance service helped wounded soldiers in the Spanish Civil War. This continued into World War II.

Helicopters were first used for medical evacuation in Burma during World War II. The US military started using them a lot during the Korean War (1950-1953). Helicopters not only took wounded soldiers off the battlefield. They also moved critical patients to hospital ships after first aid.

By 1969, in Vietnam, special medical teams and helicopters helped wounded soldiers survive better than people injured on highways in California. This inspired the first civilian paramedic services. Today, military aircraft are still used for battlefield ambulances. They also use planes for long-distance transport of wounded soldiers.

Civilian Use

A Bell 412 helicopter leaving Mojave, California.

The first civilian uses of aircraft as ambulances were often by chance. In remote parts of Canada, Australia, and Scandinavia, small planes called "bush planes" carried supplies and doctors. These pilots likely made the first civilian air ambulance trips when needed. In the early 1920s, Sweden and Thailand set up air ambulance systems.

In 1928, the first formal, full-time air ambulance service started in the Australian outback. This became the famous Royal Flying Doctor Service of Australia. It still operates today! In 1934, Marie Marvingt started Africa's first civilian air ambulance service in Morocco.

Air ambulances quickly proved useful in remote areas. But their use in developed areas grew more slowly. After World War II, Saskatchewan, Canada, started the first civilian air ambulance in North America. The Saskatchewan Air Ambulance service is still active today.

The first air ambulance service in the U.S. was founded in 1947 in Los Angeles. It was called Schaefer Air Service. It was also the first to be certified by the FAA. In the early days, air ambulances mostly transported patients. They didn't always have doctors or nurses on board.

Later, two research programs in the U.S. showed how important medical helicopters were for saving lives. These programs proved the need for such services. The challenge then was how to run them affordably. Often, government agencies that already had aircraft started using them for emergency medical services.

As the idea became popular, special civilian air ambulances appeared. On November 1, 1970,

An EMS Bell 427 helicopter in the Czech Republic.

the first permanent civilian air ambulance helicopter, Christoph 1, started in Munich, Germany. Its success led to many more "Christoph" helicopters across Germany. Austria adopted a similar system in 1983.

In the United States, the first hospital-based medical helicopter program started in 1972 in Denver, Colorado. In Ontario, Canada, the air ambulance program began in 1977. It focused on paramedics and transferring critical patients between hospitals. Today, civilian air ambulances are common worldwide. They are a vital support for ground ambulances.

How Air Ambulance Services Are Organized

Air ambulance services are organized in different ways around the world. They can be run by the military or civilians. They can be funded by the government, by fees, by businesses, or by public donations. They can also use dedicated aircraft or planes that have other jobs too.

Government-Operated Services

Sometimes, governments run air ambulance services directly. Or they hire a company to do it. These services might focus on moving very sick patients or helping at accident scenes. The government usually sets rules to control costs and safety. Examples include Ontario's ORNGE program and Poland's Lotnicze Pogotowie Ratunkowe (LPR).

A Eurocopter EC-155B from the Hong Kong Government Flying Service.

In the UK, the Scottish Ambulance Service operates two helicopters and two planes 24 hours a day.

Multi-Purpose Aircraft

In some places, it's too expensive to have dedicated air ambulances. So, aircraft used for other government jobs might also be used for medical emergencies. For example, in Australia, a helicopter used by a power company might also act as an air ambulance. In Los Angeles, fire department helicopters that fight brush fires are also set up as air ambulances.

Sometimes, the medical staff on the aircraft has a dual role. For instance, a flight paramedic might also be a police officer.

Fee-for-Service Operations

Many air ambulance services charge for their help. This is common because they are very expensive to run. Companies, hospitals, and private EMS systems often charge fees. In the European Union, most air ambulance services charge fees, unless they are funded by subscriptions. Rega in Switzerland is an example of a service that charges fees.

Services Donated by Businesses

London's Air Ambulance Charity MD 900 helicopter.

Sometimes, a business might pay for a local air ambulance service. This is a way for them to show goodwill. This is common in Europe. For example, in London, the Virgin Group used to donate to the Helicopter Emergency Medical Service. In Germany, many air ambulance operations are funded by ADAC, a large automobile club. In Australia and New Zealand, the Westpac Bank sponsors many air ambulance helicopters. These sponsors usually don't get involved in the daily operations.

Public Donations

Mi-8AMT ambulance helicopter.

Some air ambulance services rely on money raised through charity. They might also get some government help. In the UK, Scotland's air ambulance service is funded by the government. But in England and Wales, many services are funded by local charities.

The 'Association of Air Ambulance (AAA)' in the UK has done a lot to improve trauma care. They have created guidelines for high-performing air ambulance services.

Large Air Ambulances ("Heavy-Lift")

Large, fixed-wing aircraft are also used as air ambulances. In the past, only the military used these for long-distance transport of many patients. Examples include the United States Air Force and the British Royal Air Force. These planes have doctors, nurses, and medics on board. They can provide full medical support to many patients at once.

However, civilian companies are now using large and small planes too. They transport patients who need high levels of care or need to be moved back to their home countries.

Standards for Air Medical Services

Aircraft and Flight Crews

Air ambulance pilots need a lot of experience. This is because these flights are often more challenging than regular flights. After an increase in crashes in the U.S. in the 1990s, standards became much stricter. The Commission on Air Medical Transportation Systems (CAMTS) sets these high standards. CAMTS accreditation means that pilots, staff, and aircraft meet strict safety rules.

While CAMTS accreditation is voluntary, many states in the U.S. require it for air ambulance companies to operate. This ensures that services meet national safety standards. CAMTS standards are updated regularly to keep up with changes in medical transport.

In the UK, the AAA has a Code of Conduct. It ensures that fundraising, air operations, and medical care meet national rules and best practices.

Medical Control

The medical staff on an air ambulance are usually highly skilled. They often have more freedom to make medical decisions. They can assess patients, read X-rays, and interpret lab results. This helps them plan care and prepare for any issues during the flight. Some systems use strict protocols for almost all procedures. Others have doctors available full-time to guide the medical team.

Equipment and Interiors

Most air ambulances have advanced medical equipment. The challenge in helicopters is the loud noise and small space. This can make it hard to do some medical checks, like listening to a patient's chest. Also, not all aircraft have pressurized cabins. This means flight staff need special knowledge about how pressure changes affect the body and medical gases.

Many types of helicopters are used, like the Bell 206, Eurocopter EC135, and AgustaWestland AW139. Common planes include the Learjet 35, King Air 200, and Pilatus PC-12. Most aircraft carry one patient, but some can carry two. Helicopters also have stricter weather limits and usually don't fly above 10,000 feet.

Challenges

In the 1990s, the number of air ambulance crashes in the U.S. started to rise. By 2005, it reached a record high. It was once thought that these crashes were unavoidable. This was because air ambulances often flew in dangerous conditions to save lives. As a result, nearly half of all EMS worker deaths in the U.S. happened in air ambulance crashes. In 2006, the National Transportation Safety Board (NTSB) said many crashes could be avoided. This led to better government standards and CAMTS accreditation.

Cost-Effectiveness

Air ambulances are very expensive. In England, many are funded by charities. This is because ground-based services are often more cost-effective for everyday needs. The exact benefits of air medical services, like London's Helicopter Emergency Medical Service, are still being studied.

Who Works on an Air Ambulance?

The medical team on a helicopter ambulance often includes a doctor/nurse, paramedic/nurse, or nurse/nurse combination. Respiratory therapists are also becoming more common.

Retrieval Doctor/Physician

A Retrieval Doctor (called "physician" in the USA) is a medical doctor who works on air medical services. They are usually experienced in critical care, like emergency medicine or intensive care. Some general practitioners (family doctors) with broad experience also work for air ambulances. In the UK, there's a special training program for pre-hospital emergency medicine.

Flight Paramedic

A Flight Paramedic is a licensed paramedic with extra training. They are usually highly trained with at least five years of experience. They work in high-stress environments, both at accident scenes and during critical care transport. In the United States, flight paramedics can get special certifications like FP-C or CCEMT-P.

Flight Nurse

A Flight Nurse is a nurse who specializes in patient transport in aircraft. They are part of the medical team on helicopters and airplanes. They provide care for all types of patients during the flight. They also plan and prepare for missions and create patient care plans. Flight nurses can get certifications in Emergency Nursing (CEN), Flight Nursing (CFRN), or Critical Care (CCRN).

Civilian Flight Nurses

Civilian flight nurses work for hospitals, governments, or private medical transport companies. They have special training that allows them to make more medical decisions than many other nurses. Some places require flight nurses to also be paramedics or EMTs to work at accident scenes.

Hospital Flight Nurses

Military flight nurses are senior medical members of the team. They manage and care for patients during flights. They also plan missions and prepare patients for comfort and safety.

Flight nurses check patients' needs during the flight. They ask for the right medications and equipment. They provide ongoing nursing care from start to finish. They also work with the flight crew and support staff to help patients and speed up the mission. They can start emergency treatment if needed during the flight.

Transport Respiratory Practitioner

A Transport Therapist is a highly trained respiratory therapist. They are often used in long-distance transports but can also help with shorter ones. They can get special certifications like Adult Critical Care Specialist (ACCS) or Neonatal Transport Specialist (NPT).

Associations and Organizations

Aerospace Medical Association — A group where different experts share knowledge about air and space travel.
Association of Air Medical Services - A non-profit group that supports its members. They help them provide safe and effective medical care and transport.

Air Medical Organizations

BCAS - British Columbia Ambulance Service
HAI - Helicopter Association International
IAFCCP - International Air Ambulance Association of Flight & Critical Care Paramedics
HC - Human Care
RFDS - Royal Flying Doctor Service of Australia